How We Beat Insurance Pricing

We can usually beat the overall price an individual would pay if they used their health insurance policy. We’ll even cover how you can verify this with your insurance company if you are skeptical. In the limited instances we are (slightly) more expensive than insurance, we offer many other perks and cost saving benefits. Insurance reimbursement is very complex and to avoid writing a novel on the intricacies, we are going to breakdown average pricing in a very easy to understand format.

  • Baltimore Psychiatry, LLC
  • Using Health Insurance at a Public Practice
Follow-up Medication Management Baltimore Psychiatry, LLCUsing Health Insurance at a Public Practice
Follow-up Medication Management
Starting at $25/month
Cancel any time.
$120, $80, or $40
/appointment
Pricing DetailsOur most affordable options is just $25 per month and $25 per appointment. Appointment fees may be waived for long-term patients.$120 or $80 per appointment before yearly deductible is met. $40 After it has been met.
New Patient Evaluation Availability
How long will you need to wait to be accepted as a new patient?
As quickly as 72 hoursSeveral months
Follow-Up Appointment Length30 MinutesScheduled: 15-20 Minutes
Actual appointment: 5 to 15 minutes.
Wait Times≈1 Minute≈30 Minutes
Other Indirect Ways to Save MoneyNumerous! Described below this chart
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Other ways our patients can potentially save:

  1.  We offer weekend and weeknight appointment options at no additional charge so you will not need to lose income by taking time off of work to attend an appointment.
  2. We offer remote visits so there’s no travel time or expense involved.
  3. You know the expression “time is money.” We respect your time and won’t make you waste valuable time waiting to be seen. While patient emergencies can happen, our average wait time is low.
  4. We offer e-prescribing so prescriptions go directly to the pharmacy to be filled. You will not need to drop off and wait for, or return a second time to pick up, a prescription.
  5. We can help patients find the best pricing on medications when insurance does not cover them and have tools that show us what their medication co-pays are before we finalize prescriptions.
  6. Our 30-minute follow-ups mean our patients are likely to require fewer overall appointments because we have time to fully address their needs the first time.

How Insurance Pricing and Billing Works

Using health insurance what would you pay for psychiatric medication management appointments?

We use the $120/$80/$40 formula as a rough estimate when using health insurance. Before you’ve met your yearly deductible you’ll pay $120 (moderate complexity) or $80 (low complexity) per visit. After you’ve met your yearly deductible you’ll pay $40 per visit.

“Complexity” is the level your insurance is billed by the provider and is difficult to explain in simple terms. As a general oversimplification, low complexity visits are for someone who has found a medication regimen that works well for them, needs little to no medication adjustment, and has minimal needs. Moderate complexity visits are for someone who still needs significant medications adjustments or has multiple, complex needs or diagnoses.

A brief overview of how an insurance policy typically works:

John Smith has a typical insurance policy with an individual deductible of $2,000. He will be responsible for 100% of the first $2,000 per year spent on healthcare. For psychiatric medication management this would be either $120 or $80 per visit as described previously. After he has spent $2,000 on healthcare he is only responsible for co-pays until the following year. Since psychiatry is a specialty the “specialist” copay is used. His specialist copay is $40 and that would be his cost per appointment after meeting the $2,000 yearly deductible.

How the billing process works for medication management:

Jane Doe attends a medication management follow-up appointment using her insurance. The practice charges a cash price of $200. They also agreed to accept insurance. This means they agree to a predetermined rate set with the insurance company and must “write-off” the difference between their $200 cash price and the insurance reimbursement rate. Jane ‘s visit is considered “moderate complexity” and insurance pays the provider $120 for the visit. If Jane has not met her deductible for the year she will have to pay the full $120. If her deductible has already been met she only has to pay her $40 specialist copay and insurance will cover the remainder.

What about the initial evaluation pricing?

With health insurance, you would typically be responsible for around $150 for an initial evaluation prior to meeting your deductible and $40 if deductible has already been met. Evaluations are reimbursed at a much lower rate than medication management follow-ups. Unfortunately, many practices accepting insurance are rushing through these evaluations very quickly to makeup for this difference. Evaluations via insurance in public practice are typically scheduled for 45 to 60 minutes.

Calculating Exact Pricing

These are honest and accurate representations of typical insurance pricing. However, there are numerous variables among policies to consider and your costs could be significantly different. To find out exactly what your cost would be you would need to call your insurance company and ask them what they reimburse for billing codes 90792 (initial evaluation), 99213 (low complexity follow-up), and 99214 (moderate complexity follow-up). These three codes are used almost exclusively in psychiatry. If you haven’t met your deductible you’ll be responsible for the rate your insurance company provides for these codes.

Real World Pricing Comparison: First Year of Treatment Approximation
(newly diagnosed patient; moderate severity case)

  • Health Insurance
  • Baltimore Psychiatry, LLC
  • Private Cash Only Practice
Appointment Type Health InsuranceBaltimore Psychiatry, LLCPrivate Cash Only Practice
Appointment Type
$360 to 990
/year
$680
/year
$2,000
/year
Initial EvaluationDeductible not met: $150 Deductible met: $40$180$400
8 follow-up appointments;
5 moderate complexity and
3 low complexity.
Deductible not met: (5 x $120) & (3 x $80) = $840 Deductible met (8 X $40) = $320Subscription Fee: $300 Appointments: $2008 Follow-ups x $200 each = $1,600
Overall appointment time included in price220 minutes330 minutes290 minutes
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Real World Pricing Comparison: Second Year of Treatment Approximation

  • Health Insurance
  • Baltimore Psychiatry, LLC
  • Private Cash Only Practice
Appointment Type Health InsuranceBaltimore Psychiatry, LLCPrivate Cash Only Practice
Appointment Type
$160 to 480
/year
$300
/year
$800
/year
4 follow-up appointmentsDeductible not met: $80-$120 x 4 = $320-$480 Deductible met: 4 x $40 = $160Subscription Fee: $3004 Follow-ups x $200 each = $800
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